Provider Demographics
NPI:1790056430
Name:LAVOIE, MATTHEW J (PA)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:LAVOIE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6508 DEER POINTE DRIVE SUITE A
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804
Mailing Address - Country:US
Mailing Address - Phone:410-543-1957
Mailing Address - Fax:410-543-8492
Practice Address - Street 1:70 GILL AVE.
Practice Address - Street 2:PAWTUCKET CENTER, GENESIS HEALTH CARE
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02861
Practice Address - Country:US
Practice Address - Phone:401-722-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant